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Infection Control Risk Assessment (ICRA) during Construction

and Renovation1
This matrix is to be used to set guidelines on the appropriate infection prevention and control procedures
required for the type of activity depending on where the activity will occur. The Infection Prevention and
Control representative may add or omit requirements specific to a project. Recommended barriers are to be
installed before construction begins.

Step 1: Identify the Type of Construction Activity Planned:


Type A Inspection and Non-invasive activities.

Includes but is not limited to removal of ceiling tiles for visual inspection (limited to 1 tile per
50 square feet), painting, wall covering, electrical trim work, minor plumbing and activities
that do not generate dust or require cutting of walls.
Type B Small scale, short duration activities that create minimal dust.

Includes but is not limited to installation of telephone and computer cables, access to chase
spaces, cutting of walls or ceiling where dust migration can be easily controlled at the source.

Type C Any work that generates a moderate to high level of dust or requires demolition or removal of
any fixed building components or assemblies.

Includes but is not limited to sanding walls, for painting or wall coverings, removing floor
coverings, ceiling tiles and millwork, new wall construction, minor ductwork or electrical work
above ceilings, major cabling activities and any activity that cannot be completed within a
single work shift within the set containment.
Type D Major demolition and construction projects

Includes but is not limited to activities that require consecutive work shifts, heavy demolition
or removal of a complete ceiling system and new construction.

1
Matrix modified from Bartley J. Infection Control Issues in Construction and Renovation Toolkit.
Association for Professionals in Infection Control and Epidemiology, Inc. 2007; 89-91.
Step 2: Determine Risk Group Impacted by the Proposed Construction
Activity:
Lowest Risk Medium Risk High Risk Highest Risk

1. Office areas 1. All patient care 1. Emergency 1. Operating rooms,


2. Engineering units not listed in 2. Post-anesthesia including C-section
3. Environmental Groups 3 or 4. Recovery Units 2. Cardiac
Services 2. Rehabilitation 3. Labor & Delivery Catheterization
3. Cardiac rehab 4. Newborn Nurseries 3. Intensive Care Units
4. Radiology/MRI 5. Nuclear medicine 4. Oncology
5. Outpatient 6. Echocardiography 5. Infusion/Radiation
Services 7. Central Supply Therapy
6. Cafeteria- non- 8. Pediatrics, inpatient 6. Pharmacy admixture
food prep area 9. Laboratory 7. Dialysis, inpatient
10. Endoscopy 8. Sterile Processing
11. Cafeteria food prep area 9. Any area caring for
12. Anesthesia work rooms immunocompromised
patients

Step 3: Assign a Class Based on Prior Assessments:

Risk Level Construction Activity


Type ‘A’ Type ‘B’ Type ‘C’ Type ‘D’
Lowest Risk Class 1 Class 2 Class 2 Class 3/4
Medium Risk Class 1 Class 2 Class 3 Class 4
High Risk Class 1 Class 2 Class 3/4 Class 4
Highest Risk Class 2 Class 3/4 Class 3/4 Class 4

Step 4: Identify any areas surrounding the project area, assessing the
potential Impact:

Dept. Above Dept. Below Lateral Lateral Behind Front

Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

Step 5: Review traffic flow and debris control (how and when), Are hand
washing sinks going to be blocked or shut off. Is an ILSM needed?
□ Yes □ No

Step 6: Execute Requirements for Construction Procedures Based on


Classification Assignment. Copy the form on the next two pages and
complete. Completed forms should be forwarded to Infection Prevention
and Control and Planning and Construction or Facilities Management
Project Managers for department files.
Infection Control Construction Permit

Project Name: Project Number:


MOP Number: eMac Number:
Project Manager: Project Start Date:
Location of Construction: Estimated Duration:
Contractor Performing Work: Permit Expiration Date:
Construction Supervisor: Telephone:
INFECTION CONTROL RISK
YES NO CONSTRUCTION ACTIVITY YES NO
GROUP
TYPE A: Inspection, non-invasive activity GROUP : Least Risk
TYPE B: Small scale, short duration, moderate to
high levels GROUP : Medium Risk
TYPE C: Activity generates moderate to high levels
of dust, requires greater than 1 work shift for GROUP : High Risk
completion
TYPE D: Major duration and construction activities
requiring consecutive work shifts GROUP : Highest Risk

CLASS 1 A. Minimize raising dust from


E. Areas suspected of water damage, past
construction operations.
Date: or present should be sprayed with copper
B. Doors within the travel path of
8-quinolinolate or equivalent and Infection
______________ construction activity shall be kept closed.
Prevention notified.
C. Immediately replace any ceiling tile
F. Building Materials will remain dry and will
displaced during visual inspection.
be discarded if cannot be completely
Initial: D. Immediately clean any dust that may have dried in 48 hours.
been created from all surfaces.
______________
A. Provide active means of preventing
airborne dust from dispersing into G. Water-mist work surfaces to control dust
atmosphere. while cutting.
B. Seal un-used doors with duct tape or H. Wet mop and/or vacuum with HEPA –
CLASS 2 Long Mask tape. filtered vacuum before leaving area.
C. Block off and seal air vents. I. Wipe all surfaces with hospital-approved
Date:
D. Remove or isolate HVAC system in areas disinfectant.
______________ where work is being performed. J. Place adhesive mat at entrance and exit
E. Outside exhaust locations must be 30 feet of work area. Adhesive mats should be
from air intake locations unless otherwise type to remove dust and debris from
Initial: noted. footwear exiting the construction zone.
F. Lightly mist debris and contain K. All items in previous class (es) must also
______________ construction waste before transport in be performed.
tightly covered containers. Debris should
be removed daily. Do not board elevators
containing patients when removing.
A. Obtain Infection Control approval J. Lightly mist debris and contain
before construction begins. construction waste in tightly covered
B. All items in previous class (es) must containers. Debris should be removed
also be performed. daily, or more frequently, if necessary. Do
C. Construct physical barrier with anteroom not board elevators containing patients
if possible before construction begins. when removing wastes.
D. Seal holes, pipes, conduits and punctures K. Cover transport receptacles or carts.
appropriately. L. Wet mop or wipe down area immediately
E. Maintain negative air pressure @ adjacent to the construction area and just
minimum .03 inches water gauge within inside, with owner-approved disinfectant
CLASS 3
work site using HEPA-filtered air filtration daily.
units. M. Do not remove construction barriers until
Date: F. Attach 24/7 auto dialer monitoring to project is thoroughly cleaned by
system and provide emergency power. Environmental Services.
______________ N. Clean air ducts and filters in construction
G. Personnel clothing leaving work site
should be free of loose soil and debris. area prior to removing construction
(2) 2'x4' adhesive mats should also be barrier.
Initial: O. Barriers will be cleaned before removal
used.
H. Tools and carts are to be damp wiped and upon completion of the project with
______________ the approval of the Facilities Management
before leaving the construction area.
I. Vacuum work area with HEPA-filtered Project Manager.
vacuums daily. Filters are to be sealed in P. Remove barriers carefully to minimize
bags for site removal. spreading dirt and debris.
F. Maintain negative air pressure @
A. Obtain Infection Control approval
minimum .03 inches water gauge within
before construction begins.
work site using HEPA-filtered air filtration
B. All items in previous class (es) must
units.
CLASS 4 also be performed.
G. Place adhesive walk off mats at entrance
C. Construct anteroom and require
Date: to work area within anteroom.
personnel to pass through this room so
H. All personnel entering/exiting the work
______________ they can be vacuumed using a HEPA-
site are required to wear shoes covers.
filtered vacuum before leaving work site
Shoe covers must be changed each time
or wear cloth or paper coveralls that are
the worker exits the work area.
Initial: removed each time they leave the work
I. If work is in or adjacent to a critical area
site.
where airflow, temperature, and humidity
______________ D. Isolate HVAC system in area where work
levels must remain stable they will be
is being performed to prevent
monitored to maintain minimum required
contamination of duct system
levels and necessary actions taken
E. Seal holes, pipes, conduits, and
documented.
punctures appropriately.

Additional Requirements:

Date: Exceptions/Additions to this permit are noted


by attached Memoranda
Initials:
Permit Request By: Permit Authorized By:

Date: Date:

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